2f: Specialist Treatment Centres: Durban/Pietermaritzburg (PMB) Prof Arvin Bhana, Ms Leigh Adams & Ms Tara Carney Table 98: Proportion of Treatment Episodes (Durban/PMB) 50 SANCA Penthouse 53 70 52 59 56 44 7 25 26 SANCA Lulama 39-19 22 11 12 11 19 12 Newlands Park Centre 8 30 29 19 11 3 4 7 9 Riverview Manor - * * * - 7 15 8 6 SANCA Pietermaritzburg * * * * 21 34 62 32 29 Centre Ministries * * * * * * * 9 * Chatsworth Anti- Drug Forum * * * * * * * * 16 SANCA Durban- Ugu * * * * * * * * 2 Khanyani Rehabilitation Centre * * * * * * * * <1 Persons treated N576 N=378 N=413 N=790 N=1031 N=884 N=489 N=939 N=1232 over all centres * Data collection for these periods began at different times During January to e a total of 1232 patients were admitted to the eight participating treatment centres, five in Durban and one in Pietermaritzburg. Sixteen percent of patients were admitted to a newly added outpatient facility in Chatsworth. Table 99: First Admissions (Durban/PMB) 2002 Yes 79 88 82 89 82 83 81 75 72 77 No 21 12 18 11 18 17 19 25 28 23 While the overall percentage of first time admissions remains high, closer inspection of these rates shows that the long-term treatment centres such as Riverview, Newlands Treatment Centre and SANCA Lulama tend to have a greater percentage of repeat patients (42, 28, and 26 respectively). Chatsworth Anti Drug Forum also records a large number of repeat patients (43).
Table 100: Type of treatment received (Durban/PMB) Inpatient 52 47 31 22 17 35 27 Outpatient 48 52 69 78 83 65 73 Both 0 <1 <1 0 0 0 0 Table 101: Proportion of Race Groups in Treatment Centres (Durban/PMB) Black Coloured Indian White SANCA Penthouse 36 40 37 17 11 12 36 36 34 11 13 17 SANCA Lulama 57 24 24 11 10 4 17 26 31 15 40 42 Newlands Park Centre 18 24 40 18 22 10 59 44 45 6 10 6 Riverview Manor 2 1 2 0 6 0 6 5 6 92 88 92 SANCA Pietermaritzburg 51 49 48 10 13 10 16 20 20 22 18 20 Centre Ministries - 0 - - 6 - - 94 - - 0 - Chatsworth Anti- Drug Forum - - 4 - - 1 94 1 SANCA Durban- Ugu - - 87 - - 0 - - 13 - - 0 Khanyani Rehabilitation Centre - - 33 - - 33 - - 0 - - 33 Overall Race 45 32 33 10 11 8 18 33 38 27 24 21 The SANCA treatment centres based in Durban and Pietermaritzburg had the largest numbers of Black patients in outpatient centres, while Newlands Park Centre followed by SANCA Lulama in Durban had the largest proportion of Black inpatients. The Chatsworth Anti-Drug Forum had the largest proportion of Indian outpatients by far, while Riverview Manor has the highest percentage of white patients in inpatient treatment, followed by SANCA Lulama. 51
Table 102: Population Profile of Patients (Durban/PMB) 52 GENDER Male 86 89 88 91 87 86 85 84 87 Female 14 11 12 9 13 14 15 16 13 ETHNIC GROUP Black 33 22 62 43 46 45 45 33 33 Coloured 12 11 5 10 10 7 10 11 8 Indian 28 46 23 29 26 25 18 32 38 White 26 21 10 18 18 23 27 24 21 EMPLOYMENT STATUS Employed (full-time) 47 40 52 43 35 43 44 41 44 Employed (part-time) 5 7 5 6 5 4 8 7 4 Not Working 23 30 19 19 24 16 18 25 27 Apprenticeship/ Internship 1 <1 - <1 <1 <1 0 <1 <1 Student/pupil 20 20 21 26 32 32 26 22 20 Disabled 9 1 1 <1 1 <1 <1 <1 1 Housewife 4 - <1 <1 1 <1 1 <1 <1 Pensioner - - - - 1 <1 2 1 1 Other 5 1 3 4 <1 2 <1 2 2 MARITAL STATUS Married, living with spouse Married, not living with spouse Living in a nonmarried intimate relationship 33 30 27 23 19 23 29 22 21 3 5 7 8 6 3 3 4 5 7 8 11 8 7 7 14 10 12 Divorced 9 7 5 5 5 5 8 7 6 Widowed 3 2 2 <1 2 1 2 2 2 Never married (& not living in nonmarried intimate relationship) 43 48 43 55 62 59 42 53 54 Other 1 <1 2 <1 <1 2 3 2 <1 EDUCATION Pre-Primary 1 <1 4 1 2 <1 0 0 0 Primary 23 9 36 11 <1 10 9 13 8 Secondary 63 73 48 69 86 75 74 75 78 Tertiary 11 17 12 18 10 14 17 12 13 None - - - - 2 <1 <1 <1 <1 Table 102 shows the population profile of patients. Gender, educational and marital profiles remain relatively stable. On closer review of these categories, over half of female clients are White (56), followed by Black women (27). Marital patterns suggest that mostly Black (36) and Indians
(40) are single, while 66 of divorced patients are White. Indians report the highest rates of unemployment (58). In addition, over half of the students/learners in treatment are Black (52). Table 103: Referral Sources (Durban/PMB) Self/Family/Friends 44 47 43 45 39 42 53 44 55 Social Service/ Welfare 8 9 8 11 12 7 4 4 6 Employer/Work 24 19 34 19 16 20 17 17 13 Court/Correctional Services 7 14 2 9 16 16 8 11 9 Health Professionals 7 4 7 3 5 7 10 6 8 Hospital/Clinic 2 1 2 2 1 1 2 <1 1 School 5 6 4 4 9 4 4 7 6 Religious Group 1 <1 <1 <1 1 <1 <1 1 <1 Other 2 <1-7 <1 2 3 9 1 Most referrals were by self, family or friends, followed by employers, and courts or correctional services. Table 104: Age Distribution of the Treatment Population (Durban/PMB) AGE Years 2002 10-19 22 23 27 22 32 33 30 22 28 24 20-24 11 10 14 11 14 16 17 13 15 19 25-29 11 11 9 11 10 11 9 11 11 12 30-34 12 12 13 13 11 10 11 10 11 12 35-39 13 13 11 12 8 9 10 12 11 10 40-44 12 12 9 13 11 8 8 9 9 9 45-49 9 9 6 8 10 6 7 12 6 7 50-54 6 7 5 7 4 4 4 5 5 4 55+ 4 3 6 4 0 5 4 6 4 4 Notably, 43 of the population in treatment is 24 years or younger. Over half (55) of the population in treatment is between 10 and 29 years of age. 53
Table 105: Race by age of abuse under and over 20 years age (Durban/PMB) 20 years or younger Over 20 Years n n n n n n Black 75 38 117 40 130 33 124 62 176 60 266 67 Coloured 15 36 41 40 28 30 27 64 62 60 65 70 Indian 13 16 96 32 137 30 69 84 200 68 319 70 White 14 12 38 17 35 14 107 88 180 83 219 86 The above table suggests that there is a slight decrease in the percent of youth in treatment across all race groups. This decrease is most notable in the Black and Coloured treatment populations (7 and 10 drop respectively). This does mean, however, that there is a general increase in the number of older individuals (21 and over) seeking treatment. Table 106: Primary Substance of Abuse in Rank Order 1 st most frequently used (Durban/PMB) Alcohol 64 65 60 52 48 58 60 54 50 Cannabis 23 24 23 25 32 28 23 19 21 Mandrax ( white 2 4 10 13 6 3 1 1 1 pipe ) Crack Cocaine 5 4 4 7 12 7 7 11 9 PRE/OTC 1 <1 2 2 2 2 5 3 2 Ecstasy 2 <1 1 <1 <1 <1 1 <1 <1 Heroin ( sugars ) <1 1 0 <1 1 1 2 9 16 Inhalants 1 <1 0 <1 1 1 <1 1 <1 Cannabis/ Cocaine <1 <1 0 0 0 0 0 0 0 LSD <1 0 0 0 0 0 0 0 0 Other - - - - - 1 1 3 <1 Alcohol remains the most commonly abused substance among people in treatment. Cannabis, heroin and cocaine are the next three primary substances to be abused. Heroin has shown an increase of 7 in the last 6 months. This may be attributed to the inclusion of the Chatsworth Anti Drug Forum, which shows the largest percentage of sugars usage (a low quality mixture of heroin together with other substances) amongst all the sites. 54
Table 107: Primary Substance of Abuse by Age Cohort (Durban/PMB) 20 Years or Younger Over 20 Years Alcohol 17 12 11 18 10 83 88 89 82 90 Cannabis 71 70 72 70 66 29 30 28 30 34 Dagga/ Mandrax 46 20** 33 25** 33** 54 80** 67 75** 67** Crack 8** 4** 5* 10 13 92 96 95 90 87 Cocaine 32 10** 0 68 91 100 Heroin Sugars - - 0 58 43 - - 100** 42 57 Ecstasy 33* 25** 50** 0 17* 67** 75** 50** 0 83** PRE/OTC 0 0** 0 19** 4* 100 100 100 81 96 Solvents 88** 78** 75** 100 71** 12** 22** 25* 0 29** *n=1; **n=<10 More over 20 s use alcohol, and more under 20 s use cannabis. Crack/cocaine and prescription medicines/otc remain more frequently used by over 20 s, while under 20 s are more likely to use inhalants/solvents. Table 108: Secondary Substance of Abuse in Rank Order (2 nd (Durban/PMB) most frequently used) Alcohol 22 22 12 20 33 40 32 28 32 Cannabis 0 40 39 32 33 31 33 37 27 Mandrax 13 21 26 23 12 11 4 9 7 Crack/Cocaine 10 6 12 14 13 8 12 16 17 Heroin Sugars 0 1 0 <1 1 <1 2 3 5 Ecstasy 6 7 7 5 3 4 3 2 4 PRE/OTC 7 3 4 2 2 3 11 3 4 LSD 0 0 <1 0 0 0 0 0 0 Amphetamines - - - 2 0 0 0 0 0 Inhalants - - - <1 0 0 0 1 1 Other (including cigarettes) - - - - - 4 4 1 3 55 The second most frequently used drugs as reported by the treatment population are alcohol, cannabis, cocaine and Mandrax. While alcohol fluctuates around the 30 mark, cannabis, as the second most frequent substance used, appears to have decreased significantly since the last period. Ecstasy, prescription medicines and heroin, on the other hand, have increased slightly in usage (1-2).
Table 109: Mean Age by Primary Substance of Abuse (Durban/PMB) Primary substance of abuse 2002 YEARS Alcohol 38 36 35 38 35 36 35 38 35 36 Cannabis 24 22 22 22 21 21 19 21 21 22 Mandrax 24 22 22 23 21 23 22 27 27 27 Crack 26 31 32 26 32 30 33 30 28 28 Cocaine 29 36 29 24 27 28 27 29 30 28 Ecstasy 21 24 36 37 25 22 21 21 31 29 PRE 39 43 35 36 33 32 42 42 37 41 Heroin ( sugars ) Inhalants/ Solvents - - - - - - - 25 21 22 - - - - - - - - 14 18 Table 109 shows that mean age of alcohol abuse is stable at 36 years of age. Taken as an average over 3 periods, substances such as cannabis and sugars (22 years) are used by younger individuals. At the same time, the mean age of crack and cocaine users is stabilising at around 28 years but showing evidence of younger age groups using these substances. Table 110: Age of first use of Alcohol/other Drugs and age of patients in treatment (Durban/PMB) Mean age of persons in treatment Mean age of alcohol use first started Mean age of drug use first started Years 32 31 32 29 29 30 33 30 30 19 20 23 19 21 18 20 19 18 22 18 19 18 21 17 20 18 18 Table 110 shows that initiation of substance usage remains fairly stable over time. 56
Table 111: Primary Substance of Abuse by Race (Durban/PMB) BLACK COLOURED ASIAN WHITE Alcohol 49 45 46 7 8 6 15 23 23 29 24 25 Cannabis 55 38 39 15 19 14 15 27 30 14 16 17 Mandrax 0 13* 50** 33* 25** 0 33* 63** 42** 33* 0 8* Crack/ Cocaine 2 4** 12 9 23 15 27 31 46 61 42 27 Ecstasy 0 0-0 0-50** 0-50** 0 - Heroin ( Sugars ) - 0 2** - 4** 1** - 94 95-2** 2** OTC/PRE - 12** 0-12** 4-25 26-61 70 *n=1 **n=<10 From Table 111, it can be seen that alcohol is a major cause for seeking treatment across groups, closely followed by cannabis and crack. Alcohol usage remains high among Black patients (46). Heroin is exclusively present among Indian patients, while cocaine is also used more in this group than others, although usage is more dispersed. White patients make up the majority of patients treated for over-the-counter or prescription medicine (OTC/PRE) abuse. Table 112: Gender by Primary Substance of Abuse (Durban/PMB) Primary substance of abuse M F M F M F M F M F M F Alcohol 90 10 85 15 84 16 85 15 84 16 82 18 Cannabis 93 7 93 7 91 9 94 6** 88 12 94 6 Mandrax 100 0 93 7** 90 10 100 0 100 0 100** 0 Crack 92** 8* 74 26** 100 0 95 5* 88 12 93 7** Cocaine 60** 40* 91 9** 81 19 92 8* 75 25 Ecstasy 33** 66* 33* 67** 75 25 100 0 100 0 83** 17* OTC/PRE 66** 33* 46** 55** 46 54 27** 73** 34 66 50 50 Heroin ( sugars ) 100 0 86** 14* 100 0 67** 33** 98 2 97 3 *n=1; **n=<10 Table 112 shows that within treatment centres, males dominate in the use of all substances except for OTC/PRE medicines. 57
Table 113: Sources of Payment Treatment Expenses (Durban/PMB) n n n n n n Family 237 31 448 45 341 39 168 35 345 37 422 36 Self 142 18 208 21 202 23 154 32 248 27 345 29 Medical Aid 145 19 96 10 127 15 64 13 117 13 162 13 State 82 11 115 12 64 7 25 5 75 8 54 5 Employer 110 14 113 11 107 12 52 11 84 9 115 10 Other/ Unknown 52 7 11 1 23 3 13 3 46 5 78 7 Friends 3 <1 10 1 4 <1 6 1 8 1 5 <1 Total 771 100 1001 101 868 100 482 100 929 100 1181 100 Table 113 shows that sources of payment remain fairly stable over time. The steady increase in the category Other/Unknown may be attributed to the high number of individuals reporting financial support through the BP Fund. Table 114: Treatment Population: Suburb of Residence (Durban/PMB) METRO SUBSTRUCTURE Durban 40 7 4 22 31 7 7 28 - South Central 4 13 31 16 28 13 10 19 - Region North Central Region 12 14 18 8 12 16 6 9 - Inner West 21 29 16 25 4 3 5 3 - Outer West 7 30 24 27 24 26 68 38 - Other parts 2 0 0 0 <1 2 4 0 - CITY SUBSTRUCTURE Durban - - - - - - - - 62 PMB - - - - - - - - 30 Other - - - - - - - - 8 OTHER PARTS OF THE PROVINCE Other provinces Other countries Total on whom information was available 0 2 3 2 2 2 4 4 3 0 0 0 <1 0 0 0 <1 0 N=576 N=361 N=413 N=737 N=948 N=813 N=464 N=865 N=1199 58
PATIENTS YOUNGER THAN 20 YEARS Table 115: Primary substance of abuse of patients <20 years (Durban/PMB) n n n n n Alcohol 66 22 60 24 26 25 80 31 54 19 Cannabis 193 63 162 65 71 68 106 41 150 52 Mandrax 21 7 10 4 0 0 2 1 4 1 Cocaine 12 4 2 <1 0 0 0 0 10 3 Crack 2 <1 1 <1 1 1 10 4 Ecstasy 1 <1 2 <1 2 2 0 0 1 <1 OTC/PRE 0 0 0 0 1 1 6 2 1 <1 Heroin (including Sugars) 3 1 3 1 0 0 35 14 64 22 Inhalants/Solvents 6 2 7 3 3 3 11 4 5 2 Amphetamines 0 0 0 0 0 0 0 0 0 0 Other - - - - - - 8 3 2 <1 TOTAL 304 100 247 100 106 100 258 100 291 100 The most common primary substance of abuse for patients who are younger than 20 years is cannabis, followed by heroin ( sugars ) and alcohol. The increase in heroin use in this population, in the form of sugars, is a concern. 59